Tom Heston

This article by Berman et al advocates a combined role for perfusion imaging along with coronary artery calcium scoring.

2009 BERMAN screening for CAD in diabetics

If you are using a MegaSimpleDomains dedicated linux server with Simple Control Panel, and use an external DNS (i.e. using the DNS in MegaSimpleDomains domain manager), setting up a subdomain is simple, but more complicated than just adding it to your domain in Simple Control Panel. Here are the steps.

1. In Simple Control Panel, click on your domain, and add a subdomain, let’s call it <subdomain>.

2. In your external DNS, add an “A” record that points to the IP address associated with your domain. The host should be <subdomain>. This is in addition to the standard DNS setup where the host is “@” which points to the IP address of your domain.

3. you may need to restart apache. Go to Simple Control Panel, select “services”, and restart “HTTP Web Server”

Done.

Getting old and
turning grey,
I’m going downhill, but
what the hey.

Now I need glasses
and often reply
“what did you say?”
or “one more time.”

People tell me
“It beats the alternative” or
“You’re just getting wiser.”
But I feel old and
have now got arthritis.

So it’s time to give up.
Time for the young.
They can take over,
my daughter and sons.

But I am getting wiser!
and I like this alternative.
There’s still so much to explore
and so much I can give:

1. My dog needs a walk and
2. The sink needs fixed.
3. Chores need to be done…
… and so I’ve begun.

My bag of tricks
still overflows.
My cup runneth over
as everyone knows.

The party is still going,
it’s going ’til late.
But it’s time for my nap.
So can you guys wait?

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dedicated to those turning 50 on November 24th, 2009….

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Here is how to setup a domain to use a self-signed certificate using Simple Control Panel, a free control panel for a dedicated linux server hosted by GoDaddy. This way you can setup your domain to use http secure (https) using SSL. The process is different using the Plesk control panel, and very simple.

In spite of this entire process being incredibly easy (once you figure it out), I couldn’t find a step-by-step guide on how to do it, in spite of an extensive Google search. But after experimenting around a bit, it was amazing to find out how easy it was. Here’s the step-by-step guide:

1. Login to your simple control panel.

2. In the “System Configuration” section, click on “SSL Certificates”

3. Create a self-signed certificate, and assign it to the domain you which to access via https.

4. Now, once again in the “System Configuration” section, click on “Domains”

5. Edit the domain you listed in #3 above.

6. in the “SSL Certificate” drop-down list, select the self-signed certificate you created in #3 above.

7. Upload your files to “public_html” via FTP.  In Plesk, you would upload files to the “https” directory, but using Simple Control Panel, just upload your files to the regular location.

8. You can now access the files from both http:// and https:// for example, say you uploaded the file “test.txt” to your domain, in the “public_html” directory. Then, you can access “test.txt” via:

http://<yourdomain>/test.txt

- or -

https://<yourdomain>/test.txt

There is no need to SSH to your server, mess around with httpd.conf or ssl.conf or .htaccess or to even restart apache. Simple!

Here is a recent comment from a reader who follows me on Twitter.

“Thanks for your posts on Twitter about male breast cancer. I am a survivor and was in stage 2 before I went in for an examination.” – TM

Thanks to all who have taken the time to give feedback about my blog. I really appreciate the encouragement! – Tom

The Painted Veil

This book explores the difference between a life of friviolity compared to a life of character and meaning.

The movie is excellent, for me, I liked it better than the audiobook. But both really worthwhile. This is a great story. If you like, download an audiobook from your library, like I did.

Grade: A

The Painted Veil

The Five Secrets You Must Discover Before You Die

This is an interesting book that I just checked out from the library. It’s nice and short and a fast read. Here are the 5 secrets:

1. Be True to Yourself
2. Leave No Regrets
3. Become Love
4. Live the Moment
5. Give More Than You Take

Grade: B

Just listened to Anthem

It makes you think, what is real healthcare reform? A government run program, or a reinvigoration of the individual.

I liked listening to Meme Roth of NAAO talk about how it was important for the Surgeon General to set a good example, and get her weight at a healthy level.

And last year, read this really great book, Mindless
Eating: Why We Eat More Than We Think.

In the book, Brian Wansink makes a profound statement. It goes something like this: in the 1800′s, the big advance was hygiene. In the 1900′s the big advance was antibiotics and surgery. In the 2000′s, the big advance will be in personal behavior.

Let’s do something really big. Let’s do it together.

The politicians can get their win.

A national campaign to lose weight. Let’s save a lot of money and get healthy. Incentivize people to go to the gym. Guess what? Incentives work. And what do we mean by “incentivize”? Give them money.

Pay people money to exercise. Pay them to get at and stay at a healthy weight.

Healthy food costs more than junk food. Pay schools to buy more local, fresh food.

Tax junk food. Why? The carrot also needs a stick. Taxing junk food will result in people buying less of it.

Come on, politicians, stop all your arguing.

Let’s at least agree to start with the fundamentals: prevention.

Prevention is the best cure. Let’s put first things first, and get serious about getting everyone, every where, in shape. Let’s cut all the spending and get our budget in shape. It makes *us* feel good to know that our children will have a better world when they become adults. Let’s give them a clean planet, good physical health, financial responsibility, and moral clarity.

Finally, take your vitamin C. It really helps.

I fear becoming my patient.
Positron emissions where they shouldn’t be,
x-ray deflections that aren’t quite right.

On the outside he smiles,
with only the faintest hint
of the terrible, tragic, and
deathly wrong.

I give the radioactivity
- yes I’m helping! -
then, bad news comes,
the disease progresses,
and pain happens.

The wife, the child at home,
the things left undone.
The great beyond of forever.
An unstoppable tsunami,
not far off.

So I smile warmly.
We share a laugh.
We still have this moment.
We still have this joy.

Our burst of light can’t be seen,
yet it shines brighter
than the photon flux,
that hits the crystal,
inside my camera.

The scan is real,
but what does it reveal,
about what’s inside?

Clinical Question: Can we assess a myocardial perfusion and renal function simultaneously during 99m-Tc gated SPECT myocardial perfusion scanning?

Background: Cardiac function is closely related to renal function. Decreased function of one system often leads to decreased functioning in the other. The assessment of renal and cardiac function during a single study is thus appealing from a clinical standpoint. In addition, since both would be assessed after a single injection of the radioisotope, there would be a significant socioeconomic value.

Objectives: the objective of this study was to see if 99m-Tc tetrofosmin renal scintigraphy could be performed accurately (compared to Tc-99m DTPA renal scintigraphy) when don in conjunction with gated SPECT myocardial perfusion imaging. The study also looked at renal function after adenosine stress as compared to rest renal function.

Study Design: prospect evaluation of a cohort.

Participants: there were a total of 30 patients referred for clinical reasons for myocardial gated SPECT imaging. Of these, there were 24 with hypertension (including 7 with renovascular hypertension), 7 with diabetes, and 6 with dilated cardiomyopathy.

Methods: Gated SPECT stress-rest myocardial perfusion imaging was performed in standard fashion utilizing a two-day, single isotope protocol with Tc99m tetrofosmin. The next week, 24/30 patients had a standard dynamic Tc-99m DTPA renal scan for comparison with the rest Tc-99m tetrofosmin study.

The rest acquisition started out with planar dynamic and function renal imaging for 30 minutes. Then, gated SPECT myocardial perfusion images were obtained. Patient dosage of the Tc99m was about 10 mCi (370 MBq).

Stress cardiorenal imaging utilized adenosine stress testing. Renal images were acquired over 30 minutes, starting at 3 minutes into the adenosine infusion. Gating was performed using 16 frames per cardiac cycle.

The renal scans consisted of dynamic and functional imaging over 30 minutes. Values obtained included split renal function, time to peak uptake, and the uptake index for the radiotracer.

Results: On visual analysis, the renal images from Tc99m tetrofosmin were of higher quality due to the higher uptake index of tetrofosmin compared to DTPA. The split renal function as determined by 99m-Tc tetrofosmin was comparable to that obtained by Tc99m DTPA. Time to peak activity also was comparable for the two tracers.

Patients undergoing adenosine stress renal imaging overall had a statistically significant (p less than 0.005) drop in their 99m-Tc tetrofosmin uptake index as compared to the uptake index which was obtained by at rest.

Conclusion: renal function can be accurately assessed when done in conjunction with 99m-Tc tetrofosmin gated SPECT myocardial perfusion imaging and only requires a single injection of the isotope.

Source: J Nucl Med. 2009 Jul 17. [Epub ahead of print]. Single-Shot Cardiorenal Scintigraphy with 99mTc-Tetrofosmin: A Dynamic Characterization at Rest and During Adenosine Infusion. Fommei E, Bruselli L, Ripoli A, Gimelli A, Ghione S, Giorgetti A, Kush A, Tagliavia ID, Passino C, Marzullo P. “Gabriele Monasterio” Foundation, CNR Institute of Clinical Physiology, Pisa, Italy; Department of Internal Medicine, University of Pisa, Pisa, Italy. Abstract.

NuclearWiki